What is implant breast reconstruction?

This leaflet is for women having breast reconstruction at the same time as, or following a mastectomy. This leaflet will guide you through your surgery, explaining how you should prepare for your procedure, through to how you are likely to feel afterwards. It is not meant to replace the information discussed between you and your doctor, but can act as a starting point for such a discussion or as a useful reminder of the key points.

What is implant breast reconstruction?

Breast reconstruction is the surgical creation of a new breast shape using a breast implant.

What is a breast implant?

Implants have an outer shell made from silicone elastomer (similar to rubber). The shell is filled with silicone gel or saline. The surface of implants may be smooth or textured.

The implant is placed near the surface or deep to the chest wall muscle, along with a special mesh called Acellular Dermal Matrix (ADM). This mesh is made from porcine dermis (pig skin). Before use, the mesh is treated to remove all trace of the animal cells and DNA. What remains is a scaffold that allows new cells and blood vessels to grow naturally. If you need more information, please speak to your Breast Care team.

What options are available for me?

You may have a number of choices available to you. However one type of operation may be the one most suitable for you depending on your shape and build, general health, your expectations, and whether you are having or have had radiotherapy treatment to the breast or chest wall. You will discuss your options with your consultant and clinical nurse specialist before any decisions are made about your treatment.

Are there any alternatives?

Alternative types of breast reconstruction will have been discussed with you. These may include reconstruction using your own tissue (a tissue flap) with or without an implant. The tissue can be taken from a number of places in the body, although the most common sites are the back, the lower part of the abdomen, or the upper thigh.

Will I have to stay in hospital?

Yes. You will stay in hospital for about two to three days. The procedure usually takes around two hours, if you are having a mastectomy at the same time.

Is there anything I can do before I come into hospital to improve my recovery?

Yes.

• Stay calm and positive.

• It would be wise to arrange some help with cooking and housework when you come home.

• If you have small children arrange a few treats with other people they love, both during your stay in hospital and afterwards. You will need plenty of rest after your surgery.

• If you smoke, it is very important that you try hard to give up before your surgery. For free, friendly, advice and support, contact One You Kent on 0300 123 1220, or via email.

How can I prepare for my surgery?

While you wait for your surgery date, you can start preparing for your operation. Research shows that fitter patients, who are able to improve their health and activity levels before surgery, recover more quickly. Taking an active role in planning and preparing for your operation will help you:

• feel in control

• leave hospital sooner, and

• get back to normal more quickly.

To help with this, you may be contacted by a member of the One You Kent (OYK) team. OYK work in the community, and help patients improve their general health. This includes help and advice on:

• Stopping smoking

• Losing weight

• Getting more exercise

More information can be found on the following web sites.

• One You Kent (Kent Community Health)

• Fitter Better Sooner Toolkit (Royal College of Anaesthetists)

What will happen when I arrive at hospital?

On admission you will be greeted by a member of staff in the Surgical Admissions Lounge. They will discuss with you the care you will receive before your operation. You will see your breast reconstruction surgeon before surgery and will be asked to sign a consent form, please use this time to ask any last minute questions. Remember that you can withdraw your consent for treatment at any time.

Who will perform my operation?

Your breast reconstruction surgeon.

Will I have an anaesthetic?

Yes, you will have a general anaesthetic (you will be asleep). You must not eat food or chew gum for at least six hours or drink fluids for four hours before your operation. You will meet the anaesthetist before your operation.

What happens during my operation?

If you have not got enough skin left to take an implant, it may be possible to stretch the skin gradually using a tissue expander implant. Implant reconstruction using a tissue expander usually involves two operations, but can sometimes be done with one.

• The two-stage operation involves first placing an inflatable implant behind the chest muscle; this helps keep the implant in the right place and hides its outline.

• The implant is then slowly inflated by your surgeon during outpatient appointments every one or two weeks. This gradually stretches the muscle and overlying skin. The number of appointments needed varies from person to person.

Will additional procedures be needed?

It is not common to need a blood transfusion after this operation; however this may happen. If you have strong views or religious beliefs about this, please speak to your surgeon before your surgery.

If you are found to have a low blood count (anaemia) after your operation, a course of iron tablets will be prescribed. After you are discharged from hospital your GP may repeat this blood test.

Are there any risks to having the procedure?

All surgical and anaesthetic procedures carry some uncertainty and risks. The following list gives you information on the most common or most significant problems that can happen following this type of surgery. It is unlikely that you will experience all of them. Most women recover from the operation without any major discomfort.

Your surgeon will have spoken to you about the risks of implants during your reconstruction discussions.

• Extrusion is when the implant comes through the skin, due to skin loss or necrosis (tissue death). This may happen when a wound has not completely healed, or if the breast tissue covering your implants weakens. Extrusion needs further surgery and possible removal of the implant. This may result in additional scarring and/or loss of your breast tissue. Smoking can lead to a compromised blood supply due to the fact that smoking deprives the tissue of oxygen in order to heal.

• Haematoma is a collection of blood underneath the skin, which may happen after surgery. We try to prevent this by placing small drainage tubes in the wound area to allow the blood and fluid to drain into vacuumed bottles. Sometimes blood still collects and the breast may become painful and swollen. A second operation may be needed to remove the haematoma.

• Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a type of lymphoma and not cancer of the breast tissue. BIA-ALCL is a rare sub-type of T-cell non-Hodgkin lymphoma. It is one of four sub-types of ALCL which has been linked with breast implants in a small number of cases worldwide. The cause is unknown but one theory is related to the formation of thin film around the implant. If BIA-ALCL is caught early, treatment is surgical and curable, by complete removal of the capsule and implant.

  Whether a breast implant is being used for breast reconstruction or cosmetic surgery there is now a need to provide patients with information, and a discussion of BIA-ALCL must be included as part of your consent process and noted in your medical records.

• Seroma. Sometimes serous fluid (a pale yellow, transparent fluid) will collect behind the breast. Usually this is only a small amount and the body will slowly reabsorb the fluid over a few weeks. Occasionally a larger amount of fluid collects and this can be drained in the Outpatient Department (sometimes under ultrasound guidance). This may need to be done more than once.

• A wound infection can happen after any surgical procedure. If this happens it may be treated with antibiotics, and if necessary further dressings. After an infection the scars may not be quite as neat.

• Any major operation with a general anaesthetic carries a small risk of a chest infection, mainly with people who smoke.

• Deep vein thrombosis (DVT) is a blood clot in the legs. This is a possible complication following surgery and bed rest. People who are taking the oral contraceptive pill or hormone replacement therapy (HRT) and those who smoke are at the greatest risk. Occasionally clots can break off and pass to the lungs, known as a pulmonary embolus (PE). All patients are given compression socks before surgery to try to prevent this problem. You will also be given heparin injections in your abdomen each day after your operation, and be encouraged to do deep breathing and leg exercises to reduce this risk. Sometimes you will continue to have heparin injections at home for a short time.

• Wound healing can be delayed because of poor blood supply to the area, poor nutrition, and / or infection. Sometimes the wound may break down (the stitches could come apart and the wound could open), resulting in a longer hospital stay, more hospital visits to have the wound(s) checked, and possibly further surgery. Smoking increases these risks, as it can have an adverse effect on the healing of all surgical wounds. Eating a healthy diet helps good wound healing.

• Any operation will leave a permanent scar. Infection can cause a wound to re-open. This may lead to problems with scar formation such as stretching or thickening. At first, even without a healing problem, the scar will look red, slightly lumpy, and raised. Some people may be more likely to develop keloid or hypertrophic scars which are raised, itchy, and red. If you are one of these people, please discuss this with your surgeon. In most cases scars settle to become less noticeable. If you have concerns about your scar speak to your GP, who may refer you back to the hospital. Occasionally revision surgery may be done to improve the appearance of scars.

• Numbness is normal and may be permanent in your new breast.

• Although every effort will be made to make your breasts equal in size and shape, you may find that there is a difference between the two breasts. This is quite normal, but if you have any concerns or questions please talk to your surgeon. Revision surgery may be needed to improve the look of your breasts. Occasionally there is an area of excess breast tissue on the outer part of your breast. This is completely harmless, but may be irritating as it catches when moving your arm and is known as a ‘dog ear’. This can be removed with another operation.

• Psychological aspects. Most patients are pleased with the results of their surgery. Sometimes women feel very anxious about their treatment or have difficulty coming to terms with their new look because their breasts are not as they had imagined they would be or as a result of a complication. If you feel very anxious, worried about your treatment, or depressed, please speak to your breast care nurses. If you would like information about the counselling service offered, please speak to the breast care nurses.

• Sexual activities. To start with your breasts will feel tender and you may not feel up to physical contact. However you may restart your sex life as soon as you feel comfortable. Sometimes a woman is concerned that her partner hesitates to touch her and this makes the woman feel less attractive. The most likely reason is that the partner is afraid of hurting her. Couples may wish to talk over their fears and feelings with their breast care nurse or counsellor.

What happens after my operation?

• Once you return to the ward you may have visitors. In the meantime, with your permission, they can find out how you are by calling the ward.

• Wound drains are inserted into your breast(s) during surgery to allow any fluid collecting to drain away. The drainage tube is attached to a vacuum bag where the fluid is measured. The nurses will remove the drains on the doctor’s instruction, depending on the amount and colour of the fluid drained. Following removal, a small amount of leakage from the wound is common; a light gauze pad can absorb this. A wound dressing will be in place and changed after daily checks by your doctors and nurses.

• You will have a urinary catheter, which will be removed on your surgeon’s instruction. This is usually two to three days after surgery.

• You will be able to have a shower on the ward depending on the type of dressing you have; the nursing staff will be able to advise you.

Will I be in any pain?

When you wake up after your surgery, you will be in the recovery area. The nursing staff will make sure that your recovery is as pain-free as possible. Painkillers will be given to you on a regular basis for as long as you need them. Please tell the nurses if your pain continues. For the first 24 to 48 hours you will have a morphine pump controlled by you, for pain relief.

What happens after I am discharged from hospital?

• You will be sent home with a waterproof dressing on your wound. You can shower with the dressing on but do not soak in the bath.

• You should take painkillers as needed.

• You will usually be sent home with a course of antibiotics.

Will I need a follow-up appointment?

You will be seen in clinic within a week of leaving hospital, details of this appointment will be given to you before you are discharged home.

If you have an inflatable expander you will have frequent clinic visits over the next few weeks to inflate the implant/expander at regular intervals; details will be given to you by your surgeon.

What should I do when I get home?

You should be able to return to most of your normal light activities two to four weeks after your surgery, although this will vary from person to person. We recommend that you build up gradually to more strenuous tasks, such as housework or gardening. You may need to ask someone to help you for the first couple of days, as it is important that you get plenty of rest and that you set aside some time during the day for this. Do not be afraid to take some ‘time out’ for yourself to rest your mind and body.

Can I wear a bra after surgery?

Yes, you will need to wear a good supporting non-wired sports-type bra, as advised by your surgeon. It should be worn for up to three months for 23 out of 24 hours a day (including night time), and should be taken off only for showering / washing. This is to help support the underlying tissue and suture (stitch) lines while they heal. The breast care nurse will be able to measure you and make sure that the bra is comfortable for you.

When can I start driving again?

You will not be able to drive immediately after your operation. You should only think about driving when you have healed enough to wear a seat belt without pain, usually four to six weeks after surgery.

Before driving after surgery we suggest that you check with your insurance company to make sure that you have the appropriate insurance cover. Some companies ban driving for a specific period following surgery. Failure to comply with that condition would mean that you were driving without insurance, which the law regards as a serious offence.

When can I return to work?

Depending on the type of work that you do, you may be able to return to work within three to four weeks. You may feel quite tired at first. This is normal, and we suggest you talk to your employer about a gradual return to work.

When can I take up my normal sports activities?

Many sports can be resumed within a couple of weeks of surgery, but we suggest that you check with your surgeon or breast care nurse first. If the sport involves strenuous upper body movements, for example aerobics, golf, swimming, and any racquet sports, it is probably advisable to start these activities gradually at least a month after your surgery.

It is important that you continue to carry out the exercises given to you by your physiotherapist / breast care nurse and to take up other activities slowly.

What should I do if I feel unwell at home?

If you notice any excessive swelling in your ‘breast’, or develop excessive pain or fever, contact your breast care nurse Monday to Friday 9am to 5pm or go to the Emergency Department at Queen Elizabeth the Queen Mother Hospital, Margate (QEQM) where the surgical registrar on-call will see you.

• Breast Care Nurses
  Telephone: 01227 868666

• Emergency Department, QEQM
  Telephone: 01843 235030

Further information

For further information on breast reconstruction you may like to click on the following link.

• Breast Cancer Care: breast reconstruction